<script src="lib/bootstrap-datepicker.js"></script>
<script src="lib/plupload-2.1.2/js/plupload.full.min.js"></script>

<div class="row">
    <div class="col-lg-12">
        <div class="panel panel-primary">
            <div class="panel-heading">
                <strong>
                    <div ng-hide="id">
                        添加随访信息
                    </div>
                </strong>
            </div>

            <div class="panel-body">
                <form class="form-horizontal" role="form" ng-submit="submit()">
                    <div class="form-group" ng-show="error_msg">
                        <div class="col-sm-offset-1 col-sm-11">
                            <div class="alert alert-danger" role="alert">{{error_msg}}</div>
                        </div>
                    </div>

                    <input type="hidden" class="form-control" id="id" ng-model="id">

                    <div class="form-group">
                        <div class="span6  col-sm-4"  ng-hide="role == 4">
                            <label for="province" class="col-sm-4 control-label">省份</label>
                            <div class="col-sm-8 ">
                                <select ng-model="province"
                                        ng-change="provinceChanged(province)"
                                        class="form-control" id="province"
                                        ng-options="item._id as item.name for item in provinces">
                                    <option value="">请选择省份</option>
                                </select>

                            </div>
                        </div>

                        <div class="span6  col-sm-4" ng-hide="role == 4">
                            <label for="hospital" class="col-sm-4 control-label">医院</label>
                            <div class="col-sm-8 ">
                                <select ng-model="hospital"
                                        ng-change="hospitalChanged(hospital)"
                                        class="form-control" id="hospital"
                                        ng-options="item._id as item.name for item in hospitals">
                                    <option value="">请选择医院</option>
                                </select>
                            </div>
                        </div>

                        <div class="span6  col-sm-4">
                            <label for="office" class="col-sm-4 control-label">科室</label>
                            <div class="col-sm-8 ">
                                <select id="office"
                                        ng-change="officeChanged(office)"
                                        ng-model="office"
                                        class="form-control"
                                        ng-options="item._id as item.name for item in offices">
                                    <option value="">请选择科室</option>
                                </select>
                            </div>
                        </div>
                    </div>

                    <div class="form-group">

                        <div class="span6  col-sm-4">
                            <label for="doctor" class="col-sm-4 control-label">主治医生</label>
                            <div class="col-sm-8 ">
                                <select id="doctor"
                                        ng-model="doctor"
                                        class="form-control"
                                        ng-change="doctorChanged()"
                                        ng-options="item._id as item.name for item in doctors">
                                    <option value="">请选择医生</option>
                                </select>
                            </div>
                        </div>

                        <div class="span6  col-sm-4">
                            <label for="patient" class="col-sm-4 control-label">患者姓名</label>
                            <div class="col-sm-8 ">
                                <select id="patient"
                                        ng-model="patient"
                                        class="form-control"
                                        ng-options="item._id as item.name for item in patients">
                                    <option value="">请选择患者姓名</option>
                                </select>
                            </div>
                        </div>
                    </div>

                    <div class="form-group">
                        <div class="span6  col-sm-4">
                            <label for="vistrack_time" class="col-sm-4 control-label">随访日期</label>
                            <div class="col-sm-8">
                                <div class="dropdown">
                                    <a class="dropdown-toggle" id="dropdown1" role="button" data-toggle="dropdown" data-target="#"
                                       href="">
                                        <div class="input-group">
                                            <input type="text" id="vistrack_time" class="form-control" ng-model="vistrack_time">
                                            <span class="input-group-addon"><i class="glyphicon glyphicon-calendar"></i></span>
                                        </div>
                                    </a>
                                    <ul class="dropdown-menu" role="menu" aria-labelledby="dLabel">
                                        <datetimepicker ng-model="vistrack_time"
                                                        data-datetimepicker-config="{ dropdownSelector: '#dropdown1',startView:'day', minView:'day'}"></datetimepicker>
                                    </ul>
                                </div>
                            </div>
                        </div>
                    </div>

                    <div id="after_examine_grp" class="form-group">
                        <div class="span4  col-sm-8">
                            <label for="after_examine" class="col-sm-2 control-label">治疗后检验</label>
                            <div class="col-sm-4">
                                <input type="text" required="true" class="form-control" id="after_examine" placeholder="" ng-model="after_examine_desc">
                            </div>
                            <div id="percentage_examine" class="col-sm-1" />
                            <div id="container_vistrack_examine" class="col-sm-3">
                                <a id="browser_vistrack_examine" href="javascript:;">[选择文件...]</a>
                            </div>
                        </div>
                    </div>

                    <div id="after_check_grp" class="form-group">
                        <div class="span1  col-sm-8">
                            <label for="after_check" class="col-sm-2 control-label">治疗后检查</label>
                            <div class="col-sm-4">
                                <input type="text" required="true" class="form-control" id="after_check" placeholder="" ng-model="after_check_desc">
                            </div>

                            <div id="percentage_check" class="col-sm-1">
                            </div>

                            <div id="container_vistrack_check" class="col-sm-3">
                                <a id="browser_vistrack_check" href="javascript:;">[选择文件...]</a>
                            </div>
                        </div>
                    </div>

                    <div id="after_evaluation_grp" class="form-group">
                        <div class="span1  col-sm-8">
                            <label for="after_evaluation" class="col-sm-2 control-label">治疗后评估</label>
                            <div class="col-sm-4">
                                <input type="text" required="true" class="form-control" id="after_evaluation" placeholder="" ng-model="after_evaluation_desc">
                            </div>
                            <div id="percentage_evaluation" class="col-sm-1">
                            </div>
                            <div id="container_vistrack_evaluation" class="col-sm-3">
                                <a id="browser_vistrack_evaluation" href="javascript:;">[选择文件...]</a>
                            </div>
                        </div>
                    </div>

                    <div class="form-group">
                        <div class="col-sm-8">
                            <label for="evaluation" class="col-sm-2 col-sm-offset-0 control-label">评价</label>

                            <div class="col-sm-10">
                            <textarea class="form-control"  class="form-control" id="evaluation"
                                      ng-model="evaluation" rows="3"></textarea>
                            </div>
                        </div>
                    </div>

                    <div class="form-actions">
                        <button type="submit" class="btn btn-default col-sm-offset-4 col-sm-1">确定</button>
                        <button type="button" class="btn col-sm-1 cancel_btn" ng-click="cancel()">取消</button>
                    </div>
                </form>
            </div>
        </div>
    </div>
</div>